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Journal of Perinatology (2022 )Cite this article

Determine the accuracy of diagnostic codes in identifying Prenatal Opioid Exposure (POE) and Neonatal Opioid Withdrawal Syndrome (NOWS).

A cross-sectional study of 374,222 mother-infant dyads with delivery from 01/01/2010 to 12/31/2019. We ascertained maternal diagnostic codes for opioid use during pregnancy and infant diagnostic codes for drug exposure and withdrawal. We assessed sensitivity and positive predictive value (PPV) for POE and NOWS, defined using laboratory, pharmacy, and clinical data.

Maternal codes had low sensitivity (36.4%) and PPV (34.7%) for POE. Infant codes for drug exposure were neither sensitive for POE (14%) nor NOWS (31.6%) and had low PPV. Codes for newborn withdrawal had low sensitivity (31.6%) for detecting NOWS, but high PPV (85%). Sensitivity improved (95.1%) for NOWS requiring pharmacologic treatment.

Diagnostic codes identify POE and NOWS poorly. Improved case identification would include pharmacy and laboratory results, and clearly defined criteria for evidence of withdrawal.

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All analyses were performed using SAS version 9.4. The code used is available upon request.

The datasets generated for this study are stored at the KPNC Division of Research. Deidentified data can be provided upon reasonable request to the corresponding author, and with permission from the KPNC Institutional Review Board.

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This project was supported by FDA Contract 75F40119C10101. CIC receives funds through her institution from the Opioid Postmarketing Requirements (PMR) Consortium for research on risks of long-term prescription opioid use, conducted as part of a Food and Drug Administration postmarketing requirement for extended-release and long-acting opioid analgesics. The remaining authors have no financial relationships relevant to this article to disclose.

Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA

Michael W. Kuzniewicz, Cynthia I. Campbell, Sherian Li, Eileen M. Walsh, Lisa A. Croen & Monique Hedderson

Department of Pediatrics, University of California, San Francisco, CA, USA

Department of Pediatrics, Kaiser Permanente Northern California, Oakland, CA, USA

Department of Psychiatry, Columbia University, New York, NY, USA

Department of Statistics, University of California, Berkeley, CA, USA

Department of Anesthesiology and Pediatrics, Columbia University, New York, NY, USA

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MWK conceptualized and designed the study, obtained funding, acquired the data, carried out all data analysis, drafted the initial manuscript, and reviewed and revised the manuscript. CIC, SDC, LAC, SDP, and MH assisted in interpreting the analyses, assisted in writing the initial draft, and reviewed and revised the manuscript. SL was responsible for acquiring the data, building the datasets, and reviewing and revising the manuscript. EMW reviewed the data, performed chart review for data accuracy when needed, and reviewed and revised the manuscript. LSS assisted in the conceptualization and design of the study, obtained funding, reviewed data analyses, assisted in writing the initial draft and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Correspondence to Eileen M. Walsh.

The authors declare no competing interests.

The study was reviewed and approved by the following boards. Individual consent of subjects was waived. Kaiser Permanente Northern California Institutional Review Board (#1507334). California Committee for the Protection of Human Subjects (#2021-043). The study is in accordance with the Declaration of Helsinki.

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Kuzniewicz, M.W., Campbell, C.I., Li, S. et al. Accuracy of diagnostic codes for prenatal opioid exposure and neonatal opioid withdrawal syndrome. J Perinatol (2022). https://doi.org/10.1038/s41372-022-01518-y

DOI: https://doi.org/10.1038/s41372-022-01518-y

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Journal of Perinatology (J Perinatol) ISSN 1476-5543 (online) ISSN 0743-8346 (print)